| NPI | 1881165082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT5461) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL4461) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NM AT667) | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |